New support for rewarding organ donations / Medals, funeral funds for families suggested in position paper

John M. Hubbell, Chronicle Staff Writer

Published
4:00 am PDT, Thursday, June 20, 2002

While stopping far short of paying cash for kidneys, the federal government should encourage organ donorship in other ways, from congressional medals for the living to funeral funds for families of the dead, a position paper in today's New England Journal of Medicine contends.

The paper -- co-written by a Berkeley founder of Organs Watch (which monitors the largely illegal international human organs trade) -- adds to gathering support in the medical community for Congress to repeal its 1984 ban on financial rewards for the donation of body parts.

Several proposals introduced this congressional year aim to dismantle the ban in various forms, addressing the widely held belief among transplant experts that the volunteer-driven system now in place is lopsided and failing.

More than 80,000 U.S. patients currently need a transplant, according to the United Network for Organ Sharing. By contrast, about 24,000 transplants occurred in 2001 in the shadow of similar demand, according to network statistics.

Today's paper follows by two days a vote by the policy-making arm of the American Medical Association to support studying an incentive-based approach to transplants from cadavers. It also comes about two months after the ethics branch of the American Society of Transplant Surgeons backed paying families a small sum for agreeing to donate a relative's organs.

Proposals endorsed in today's Journal also "hang onto the idea that there is a difference between outright payment and incentives," said Nancy Scheper- Hughes, the UC Berkeley anthropologist who co-founded Organs Watch. Inherent in a pay-per-organ system "is the notion that your body is not worth as much as the other," she said.

While backing the continued prohibition of payment for organs inside the United States, the position paper makes passing acknowledgment that U.S. hospitals have performed transplants that result from an illicit transaction elsewhere.

Meanwhile, among other things, it supports:

-- bestowing congressional "donor medals of honor" upon living donors, and to the families of deceased donors;

-- a $300 reimbursement for funeral expenses to families of donors, the move also endorsed by the transplant surgeons; and

-- a national plan for life and disability insurance for living donors, given that their act "is not a risk-free procedure."

The paper's authors oppose proposals that more explicitly tie monetary incentives to donations. They include a $10,000 "Gift of Life Tax Credit" proposed by Rep. James Hansen, R-Utah, and a $2,500 tax refund offered by Rep. Chris Smith, R-N.J. Both, the article states, "place an arbitrary monetary value on an organ and in reality are merely forms of payment."

One Northern California transplant expert agreed with the rationale. While incentives may well be designed to alleviate the chronic shortage, any enticement -- especially one that carries a dollar sign -- has "a significant potential . . . to be misunderstood," said Dr. Roblee Allen, director of lung transplants at UC Davis' Transplant Center.

Public recognition "may indeed be a very strong thing," he said, but "money leaves a cold taste in my mouth."

Although the Journal paper she co-wrote supports some incentives that carry tacit financial gain, Scheper-Hughes notes they "could backfire."

"Who is going to feel they're being bribed into something?" she asked.